trimethoprim--sulfamethoxazole-drug-combination and Streptococcal-Infections

A case of cervical spine infection due to Streptococcus anginosus is reported. Streptococcus milleri is encountered in the mouth, gastro-intestinal tract, vagina and nasopharynx. It is an uncommon pathogen responsible of suppurative infections such as brain liver or spleen abscesses, intra-abdominal or soft tissue abscesses and pleural empyema. In rare cases it can cause spondylodiscitis and osteomyelitis. Based on the review of eight cases of spondylodiscitis or osteomyelitis, diagnosis and treatment are discussed.

Topics: Adult; Ampicillin; Cervical Vertebrae; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Neck Pain; Spondylitis; Streptococcal Infections; Streptococcus; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Topics: Anti-Bacterial Agents; Bacterial Infections; Child; Chloramphenicol; Drug Combinations; Haemophilus Infections; Haemophilus influenzae; Humans; Infant, Newborn; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vancomycin

This study aimed to evaluate steroid hormones in foals born from mares treated for ascending placentitis with different combinations of trimethoprim-sulfamethoxazole (TMS), flunixin meglumine (FM), long-acting altrenogest (ALT) and estradiol cypionate (ECP) for ten consecutive days, starting two days after experimental induction of placentitis with Streptococcus zooepidemicus. Fourty-six pregnant mares and respective foals were assigned as healthy group (Control, n = 8) or treated groups as follows: TMS+FM (n = 8), TMS+FM+ALT (n = 8), TMS+FM+ALT+ECP (n = 6), TMS+FM+ECP (n = 6) and no treatment (NO TREAT n = 10). At delivery, foals were classified as high-risk or low-risk based on clinical and hematologic findings, and survival rates were recorded during the first week of life for comparisons across groups. Cortisol, progesterone, 17αOHprogesterone, and pregnenolone concentrations were determined via immunoassays in 31 of the 46 foals immediately after foaling (0 h), at 12, 24, 48 h, and seven days post-partum (168h). At birth, serum cortisol concentrations were higher in Control and TMS+FM+ECP foals than in remaining groups (p < 0.05). Foals in TMS+FM+ALT and TMS+FM groups had higher 17αOHprogesterone concentrations at 24 h and 48 h, respectively (p < 0.05). Pregnenolone concentrations were higher in TMS+FM than TMS+FM+ALT+ECP foals at 7 days (p < 0.05). High-risk and non-surviving foals had decreased concentrations of cortisol at parturition, but increased concentrations of progesterone from 0 h to 48 h. Pregnenolone and 17αOHprogesterone concentrations were increased and pregnenolone after 12 h in high-risk and non-surviving foals (p < 0.05). In conclusion, adding ECP to the treatment of experimentally-induced placentitis appears to improve foal viability and endocrine response. Cortisol and progestogen profiles were abnormal in high-risk and non-surviving foals, and those treated with ALT or TMS+FM only.

Topics: 17-alpha-Hydroxyprogesterone; Animals; Animals, Newborn; Anti-Bacterial Agents; Clonixin; Contraceptive Agents, Female; Estradiol; Female; Horse Diseases; Horses; Hydrocortisone; Placenta Diseases; Pregnancy; Pregnenolone; Progesterone; Progestins; Random Allocation; Streptococcal Infections; Streptococcus equi; Trenbolone Acetate; Trimethoprim, Sulfamethoxazole Drug Combination

Two large randomized trials recently demonstrated efficacy of methicillin-resistant Staphylococcus aureus (MRSA)-active antibiotics for drained skin abscesses. We determine whether outcome advantages observed in one trial exist across lesion sizes and among subgroups with and without guideline-recommended antibiotic indications.. We conducted a planned subgroup analysis of a double-blind, randomized trial at 5 US emergency departments, demonstrating superiority of trimethoprim-sulfamethoxazole (320/1,600 mg twice daily for 7 days) compared with placebo for patients older than 12 years with a drained skin abscess. We determined between-group differences in rates of clinical (no new antibiotics) and composite cure (no new antibiotics or drainage) through 7 to 14 and 42 to 56 days after treatment among subgroups with and without abscess cavity or erythema diameter greater than or equal to 5 cm, history of MRSA, fever, diabetes, and comorbidities. We also evaluated treatment effect by lesion size and culture result.. Among 1,057 mostly adult participants, median abscess cavity and erythema diameters were 2.5 cm (range 0.1 to 16.0 cm) and 6.5 cm (range 1.0 to 38.5), respectively; 44.3% grew MRSA. Overall, for trimethoprim-sulfamethoxazole and placebo groups, clinical cure rate at 7 to 14 days was 92.9% and 85.7%; composite cure rate at 7 to 14 days was 86.5% and 74.3%, and at 42 to 56 days, it was 82.4% and 70.2%. For all outcomes, across lesion sizes and among subgroups with and without guideline antibiotic criteria, trimethoprim-sulfamethoxazole was associated with improved outcomes. Treatment effect was greatest with history of MRSA infection, fever, and positive MRSA culture.. Treatment with trimethoprim-sulfamethoxazole was associated with improved outcomes regardless of lesion size or guideline antibiotic criteria.

Topics: Abscess; Adolescent; Adult; Aged; Anti-Bacterial Agents; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Middle Aged; Skin Diseases, Bacterial; Staphylococcal Skin Infections; Streptococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Streptococcus pyogenes is commonly believed to be resistant to trimethoprim-sulfamethoxazole (SXT), resulting in reservations about using SXT for skin and soft tissue infections (SSTI) where S. pyogenes is involved. S. pyogenes' in vitro susceptibility to SXT depends on the medium's thymidine content. Thymidine allows S. pyogenes to bypass the sulfur-mediated inhibition of folate metabolism and, historically, has resulted in apparently reduced susceptibility of S. pyogenes to sulfur antibacterials. The low thymidine concentration in Mueller-Hinton agar (MHA) is now regulated. We explored S. pyogenes susceptibility to SXT on various media. Using two sets of 100 clinical S. pyogenes isolates, we tested for susceptibility using SXT Etests on MHA containing defibrinated horse blood and 20 mg/liter β-NAD (MHF), MHA with sheep blood (MHS), MHA alone, MHA with horse blood (MHBA), and MHA with lysed horse blood (MHLHBA). European Committee on Antibacterial Susceptibility Testing (EUCAST) breakpoints defined susceptibility (MIC, ≤ 1 mg/liter) and resistance (MIC, >2 mg/liter). In study 1, 99% of S. pyogenes isolates were susceptible to SXT on MHA, MHBA, and MHLHBA, with geometric mean MICs of 0.04, 0.04, and 0.05 mg/liter, respectively. In study 2, all 100 S. pyogenes isolates were susceptible to SXT on MHF, MHS, MHA, and MHLHBA with geometric mean MICs of 0.07, 0.16, 0.07, and 0.09 mg/liter, respectively. This study confirms the in vitro susceptibility of S. pyogenes to SXT, providing support for the use of SXT for SSTIs. A clinical trial using SXT for impetigo is ongoing.

Topics: Adolescent; Animals; Anti-Bacterial Agents; Child; Child, Preschool; Culture Media; Humans; Infant; Microbial Sensitivity Tests; Streptococcal Infections; Streptococcus pyogenes; Trimethoprim, Sulfamethoxazole Drug Combination

The study was undertaken to compare the safety and efficacy of twice-daily ciprofloxacin for 3 days with standard 7 day therapy with either co-trimoxazole or nitrofurantoin in the treatment of women with acute, uncomplicated urinary tract infections (UTI). This multicentre, prospective, randomized, double-blind trial compared oral ciprofloxacin (100 mg bd) for 3 days with co-trimoxazole (160/800 mg bd) or nitrofurantoin (100 mg bd) for 7 days. Bacteriological and clinical evaluations were performed at study entry, during therapy and 4-10 days and 4-6 weeks after the completion of therapy. The primary efficacy parameter was eradication of the causative organism 4-10 days following treatment. Of 713 women enrolled and evaluable for safety, 521 were evaluable for efficacy (168 ciprofloxacin, 174 co-trimoxazole, 179 nitrofurantoin). Escherichia coli (83%) was the most frequently isolated pathogen in all treatment groups. Bacteriological eradication was reported in 88% of ciprofloxacin patients, 93% of co-trimoxazole patients and 86% of nitrofurantoin patients. At the 4-6 week follow-up, ciprofloxacin had statistically significantly higher eradication rates (91%) than co-trimoxazole (79%; 95% confidence limit (CL) = -20.6%, -3.9%) and nitrofurantoin (82%; 95% CL = -17.1%, -0.9%). Clinical resolution 4-10 days after therapy and at the 4-6 week follow-up was similar among the three treatment groups. The overall incidence of treatment-emergent adverse events was not significantly different (P = 0.093) among the three drug regimens, although co-trimoxazole was associated with a greater number of adverse events than ciprofloxacin (P < or = 0.05). Ciprofloxacin also caused fewer episodes of nausea than either of the other agents (P < or = 0.01).

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Anti-Infective Agents, Urinary; Ciprofloxacin; Cystitis; Dose-Response Relationship, Drug; Double-Blind Method; Escherichia coli Infections; Female; Humans; Middle Aged; Nitrofurantoin; Prospective Studies; Staphylococcal Infections; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a controlled randomized study among 48 patients undergoing 75 courses of aggressive antileukemic therapy, it was shown that cotrimoxazole was less effective than penicillin G in preventing septicemia due to viridans streptococci. Both antibiotics were given intravenously. During 35 episodes of chemotherapy in the group of patients on penicillin G only, one patient developed a streptococcal bacteremia; this contrasted with bacteremia and septicemia in seven patients during 40 episodes in the group on cotrimoxazole. In three of these seven patients, septicemia was associated with respiratory failure and it was the cause of death in one. Both aerobic gram-negative rods and streptococci which caused infection despite cotrimoxazole prophylaxis were resistant to cotrimoxazole. Side effects such as hypersensitivity and favorable or unfavorable interaction with the oral selective decontamination regimen were similar for the two drugs, with the exception of colonization with Candida spp, which occurred more often in patients on cotrimoxazole than in patients on penicillin.

Topics: Agranulocytosis; Antineoplastic Agents; Bacteremia; Drug Hypersensitivity; Drug Interactions; Drug Resistance, Microbial; Humans; Length of Stay; Leukemia; Penicillin G; Streptococcal Infections; Streptococcus; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

We evaluated the following five treatment regimens for acute cystitis in nonpregnant women: cefadroxil, 1,000 mg single-dose; cefadroxil, 500 mg twice a day for three days; cefadroxil, 500 mg twice a day for seven days; trimethoprim-sulfamethoxazole (TMP-SMZ), 320-1,600 mg single-dose, and TMP-SMZ, 160-800 mg twice a day for three days. At four weeks after the end of treatment, 25%, 58%, 70%, 65%, and 88% of patients, respectively, remained cured of infection. The results indicated that three-day treatment (1) might improve cure rates (over single-dose), (2) would reduce incidence of relapse (vs. single-dose), and (3) may be as curative as seven-day treatment. The results of the antibody-coated bacteria test did not predict treatment failure or relapse.

Topics: Administration, Oral; Antibody-Coated Bacteria Test, Urinary; Bacteriuria; Cefadroxil; Cystitis; Drug Combinations; Enterobacteriaceae Infections; Female; Humans; Random Allocation; Recurrence; Staphylococcal Infections; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

24 patients, admitted to hospital with lower respiratory tract infection, were treated with either co-trimoxazole (800 mg sulphamethoxazole + 160 mg trimethoprim) or trimethoprim (200 mg) orally twice daily. All showed a clinical improvement and with one exception respiratory pathogens were eliminated. Pharmacokinetics in blood, sputum and saliva were studied in 11 patients taking trimethoprim and 9 taking co-trimoxazole. No sulphamethoxazole was detected in either the sputum or saliva. Trimethoprim was found in higher concentrations in the sputum than in the blood, although there were wide and significant variations in individual patient's sputum pharmacokinetic profiles. Trimethoprim penetrates into the sputum at therapeutic concentrations in patients with chronic respiratory infections.

Topics: Adolescent; Adult; Aged; Drug Combinations; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Respiratory Tract Infections; Saliva; Sputum; Staphylococcal Infections; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Of 545 patients expected to develop prolonged neutropenia and randomized to received trimethoprim-sulfamethoxazole (TMP-SMZ) or placebo, 342 were evaluable for occurrence of infection or bacteremia. Some centers used oral nonabsorbable antibiotics in addition. Infection occurred in 64 (39%) of 165 placebo recipients and 46 (26%) of 177 TMP-SMZ recipients (P = .016), whereas bacteremia occurred in 32 (19%) and 22 (12%), respectively (P = .106, difference not significant [NS]). In the 139 patients with acute nonlymphocytic leukemia (ANLL), infection occurred in 35 (55%) of 64 placebo-treated patients and 31 (41%) of 75 TMP-SMZ-treated patients (P = .162, NS), whereas bacteremia occurred in 15 (23%) and 18 (24%; NS), respectively. Excluding patients with ANLL, infection occurred in 29 (29%) of 101 placebo-treated patients and 15 (15%) of 102 TMP-SMZ recipients (P = .038), whereas bacteremia occurred in 17 (17%) and four (4%; P = .005), respectively. Gram-positive cocci were isolated less frequently from TMP-SMZ-treated, bacteremic patients, but more of their isolates were resistant to TMP-SMZ than were those from placebo recipients.

Topics: Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Drug Combinations; Enterobacteriaceae Infections; Granulocytes; Humans; Leukemia; Leukocyte Count; Neutropenia; Sepsis; Staphylococcal Infections; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Infective Agents; Camphanes; Child; Child, Preschool; Drug Combinations; England; Family Practice; Female; Humans; Infant; Male; Respiratory Tract Infections; Staphylococcal Infections; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Nasal tip abscesses in children are uncommon. We report on 7 children/teenagers who presented with an advanced nasal tip abscess that required intravenous antibiotics and surgical drainage, despite adequate pre-admission antibiotic therapy with amoxicillin/clavulanic acid or cephalosporins. Cultures were positive for Staphylococcus aureus, that was clindamycin-resistant but TMP/SMX sensitive.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Child; Drainage; Drug Resistance, Bacterial; Female; Gram-Positive Bacterial Infections; Humans; Male; Nose Diseases; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes; Trimethoprim, Sulfamethoxazole Drug Combination

To estimate the prevalence of antibiotic resistance in indicator bacteria Escherichia coli and Enterococci isolated from duck faeces in Morogoro Municipality, Tanzania.. Escherichia coli and Enterococcus isolation rates from ducks faeces were 91 and 100% respectively. The prevalence of antibiotic resistance of E. coli and Enterococcus was 70.3 and 42%, respectively. E. coli resistant to four antibiotics were 28 (30.8%) and showed high resistance to ampicillin (81.3), tetracycline (75.8) and trimethoprim-sulphamethoxine (62.3). Multiple antibiotic resistance of Enterococcus were more than 65%. High resistance rates shown by Enterococcus were observed in rifampin (62%), ampicillin (62%) and tetracycline (42%). Almost all farmers (92.3%) left their ducks to scavenge for food around their houses. Antibiotics used in animal treatments were oxytetracyclines, sulfonamides, penicillin dihydrostreptomycin while in humans were tetracycline, ampicillin, and amoxicillin.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Asymptomatic Diseases; Drug Resistance, Multiple, Bacterial; Ducks; Enterococcus; Escherichia coli; Escherichia coli Infections; Feces; Female; Humans; Male; Microbial Sensitivity Tests; Poultry; Poultry Diseases; Rifampin; Streptococcal Infections; Tanzania; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

It is erroneously believed that group A streptococci (GAS) are universally resistant to trimethoprim-sulfamethoxazole (TMS). This is mainly because media commonly used for in vitro determination of susceptibility to antibiotics contain thymidine, a nucleoside that antagonizes the antibiotic effect of TMS. The objective of this work was to determine EGA sensitivity to TMS in the presence and absence of thymidine. To this aim, 95 GAS isolates obtained from clinical tissues with i nvasive infections were analyzed. Susceptibility tests were performed by diffusion with TMS discs in Mueller Hinton agar supplemented either with 5% sheep blood or with 5% lysed equine blood (MH-LEB). Lysed equine blood contains thymidine phosphorylase, which degrades this nucleoside. Epsilometry (Etest) was used as gold standard. Quality controls with Enterococcus faecalis strain ATCC 29212 were satisfactory with both media. A 100% sensitivity to TMS was found in MH-SEL whereas 6 isolates (6.3%) resulted resistant in MH-SC; only one of them was found to have intermediate susceptibility by Etest (MIC > 1.5/28 υg/ml). The genetic determinants most frequently associated to TMS resistant EGA were not found in this isolate. Probably, if more accurate GAS-specific cut-off points were established for diffusion, the correlation with dilution methods or with the Etest could be improved, even employing MH-SB.

Topics: Anti-Bacterial Agents; Culture Media; Humans; Microbial Sensitivity Tests; Polymerase Chain Reaction; Streptococcal Infections; Streptococcus pyogenes; Trimethoprim, Sulfamethoxazole Drug Combination

The overall goal of this study was to assess the efficacy of various therapeutic combinations of estradiol cypionate (ECP, a long-acting estrogen) and altrenogest (ALT, a long-acting progestin) in addition to basic treatment for placentitis with trimethoprim-sulfamethoxazole (TMS) and flunixin meglumine (FM). Specific outcomes measured in this experiment were (i) time from induction of bacterial placentitis to delivery, and foal parameters (high-risk, survival, and birth weight); and (ii) serum steroid concentrations (progesterone, 17α-hydroxyprogesterone, 17β-estradiol, and cortisol) in response to treatment. Pregnant mares (∼300 days gestation, n = 46) were randomly assigned into healthy mares (control group, CONT, n = 8) and mares with experimentally induced ascending placentitis (n = 38). Placentitis was induced via intracervical inoculation of Streptococcus equi subspecies zooepidemicus. Thereafter, placentitis induced mares were randomly assigned into: (1) basic treatment, TMS+FM (n = 8); (2) basic treatment with ALT supplementation, TMS+FM+ALT (n = 8); (3) basic treatment with ECP supplementation, TMS+FM+ECP (n = 6); (4) basic treatment with ALT and ECP supplementation TMS+FM+ALT+ECP (n = 6); and (5) no treatment (INOC, n = 10). Treatments were started 48 h after bacterial inoculation and carried out for ten consecutive days. Blood samples were collected daily, and mares were assessed for signs of placentitis until the mare delivered, or for ten consecutive days after onset of treatment. Steroids were analyzed via RIA. Continuous data were analyzed by ANOVA, and categorical data analyzed by Fisher's exact test. Significance was set at p < 0.05. Foal survival at parturition and seven days post-delivery were similar across treated groups (66.7-100%), and to the CONT group. Similar to CONT group, mares in the TMS+FM+ECP group had no high-risk foals while mares in the other groups had higher incidences (50-75%) (p < 0.05). The inclusion of ECP in the treatments resulted in foals with body weight similar to CONT group (p > 0.05). There were no group effects or time by group interactions on concentrations of steroids assessed herein (p > 0.05). In conclusion, in addition to basic treatment TMS+FM, mares with experimentally induced ascending placentitis benefited from ECP supplementation. Conversely, ALT did not appear to make a difference in outcomes. The immunoassays used for measurements of steroid concentrations did not appear useful to assess treatme

Topics: Animals; Anti-Bacterial Agents; Clonixin; Drug Therapy, Combination; Estradiol; Female; Horse Diseases; Horses; Placenta Diseases; Pregnancy; Pregnancy Complications, Infectious; Streptococcal Infections; Streptococcus equi; Trenbolone Acetate; Trimethoprim, Sulfamethoxazole Drug Combination

A 19-year-old man with chronic lymphoedema due to Noonan syndrome presented at our hospital with septic shock and pain in his lower leg. Blood cultures were positive for Streptococcus dysgalactiae subsp equisimilis (SDSE), resulting in a diagnosis of cellulitis with toxic involvement. He was treated with ampicillin for 3 weeks. Although he did well for 6 weeks, septic shock recurred. Blood culture again revealed SDSE, with the strain being identical to the first episode, suggesting that this infection had relapsed. He was treated with ampicillin for 6 weeks and prophylactically with trimethoprim-sulfamethoxazole for 12 months. Although SDSE bacteraemia occurs commonly in elderly patients, findings in this patient showed that it can also develop in younger persons with predisposing factors. This case also indicates that SDSE has the potential to recur, despite generally sufficient antibiotic administration, and that patients who experience recurrent episodes may require prolonged treatment with antibiotics, including prophylaxis.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteremia; Humans; Male; Noonan Syndrome; Recurrence; Shock, Septic; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Neonatal mastitis is a rare occurrence in the horse. This report documents a case of mastitis caused by an organism within the Streptococcus dysgalactiae group in a 1-week-old Paint filly.

Topics: Animals; Animals, Newborn; Anti-Bacterial Agents; Female; Horse Diseases; Horses; Mastitis; Streptococcal Infections; Streptococcus; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Acute Disease; Anti-Bacterial Agents; Clindamycin; Dental Care; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Iris Diseases; Middle Aged; Streptococcal Infections; Streptococcus intermedius; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Predisposing factors of pyogenic odontogenic infection include dental caries, pericoronitis, periodontitis, trauma to the dentition and the supporting structures or complications of dental procedures. The infections are usually polymicrobial involving normal endogenous flora. We characterised pyogenic odontogenic infection in patients attending Mulago Hospital, Uganda.. Of the 130 patients, 62 (47.7%) were female. The most frequently involved fascial spaces were: the buccal, 52 (25.4%); submasseteric, 46 (22.4%) and the submandibular space, 36 (17.5%). Dental caries was the most prevalent predisposing factor, particularly of the lower third molar teeth. Viridans Streptococci Group and Staphylococcus aureus were the most frequent bacterial isolates: 23.5% and 19.4%, respectively. All Viridans Streptococci isolates were resistant to penicillin G, sulfamethoxazole/trimethoprim (cotrimoxazole), ampicillin and tetracycline, but susceptible to vancomycin. All Staphylococcus aureus strains were resistant to cotrimoxazole and ampicillin while retaining susceptibility to vancomycin, cefotaxime, linezolid, moxifloxacin and amoxicillin/clavulanate. Thirty five (26.9%) patients were HIV infected and the HIV status did not significantly influence the pattern of odontogenic infection.. Dental caries was the most prevalent predisposing factor for pyogenic odontogenic infection. High prevalence of bacterial resistance to ampicillin and cotrimoxazole suggests the need for regular antibiotic susceptibility tests of isolates and rational use of antibiotics in the management of these infections. Prevention requires strengthening of oral health in the community.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Coinfection; Cross-Sectional Studies; Dental Caries; Drug Resistance, Multiple, Bacterial; Female; HIV; HIV Infections; Hospitals; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Periodontitis; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Uganda; Viridans Streptococci

A nationwide laboratory-based surveillance study of invasive S. pyogenes infections was conducted in Germany. Invasive isolates (n = 1,281) were obtained between 2003 and 2013. All isolates were susceptible to penicillin, cefotaxime and vancomycin. Tetracycline showed the highest rate of resistant or intermediate resistant isolates with 9.8%, followed by macrolides (4.0%), trimethoprim/sulfamethoxazole (SXT) (1.9%), levofloxacin (1.3%), chloramphenicol (0.9%) and clindamycin (0.7%). The most prominent trends were the appearance of levofloxacin non-susceptible isolates since 2011, and an increase of SXT non-susceptibility since 2012.

Topics: Anti-Bacterial Agents; Cefotaxime; Chloramphenicol; Clindamycin; Epidemiological Monitoring; Germany; Humans; Levofloxacin; Macrolides; Microbial Sensitivity Tests; Penicillins; Streptococcal Infections; Streptococcus pyogenes; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Periorbital infections after strabismus surgery are rare. We describe the first reported case of necrotizing group A streptococcal infection of the conjunctiva and Tenon's capsule complicating uneventful strabismus surgery in a 23-month-old boy, successfully managed with conservative intraoperative debridement and with targeted local and systemic antibiotics.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Conjunctivitis, Bacterial; Esotropia; Eye Infections, Bacterial; Fasciitis, Necrotizing; Humans; Infant; Male; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Penicillin G; Streptococcal Infections; Streptococcus pyogenes; Tenon Capsule; Trimethoprim, Sulfamethoxazole Drug Combination

Blood-stream infection (BSI) is one of the principle determinants of the morbidity and mortality associated with advanced HIV infection, especially in sub-Saharan Africa. Over the last 10 years, there has been rapid roll-out of anti-retroviral therapy (ART) and cotrimoxazole prophylactic therapy (CPT) in many high HIV prevalence African countries.. A prospective cohort of adults with suspected BSI presenting to Queen's Hospital, Malawi was recruited between 2009 and 2010 to describe causes of and outcomes from BSI. Comparison was made with a cohort pre-dating ART roll-out to investigate whether and how ART and CPT have affected BSI. Malawian census and Ministry of Health ART data were used to estimate minimum incidence of BSI in Blantyre district.. 2,007 patients were recruited, 90% were HIV infected. Since 1997/8, culture-confirmed BSI has fallen from 16% of suspected cases to 10% (p<0.001) and case fatality rate from confirmed BSI has fallen from 40% to 14% (p<0.001). Minimum incidence of BSI was estimated at 0.03/1000 years in HIV uninfected vs. 2.16/1000 years in HIV infected adults. Compared to HIV seronegative patients, the estimated incidence rate-ratio for BSI was 80 (95% CI:46-139) in HIV-infected/untreated adults, 568 (95% CI:302-1069) during the first 3 months of ART and 30 (95% CI:16-59) after 3 months of ART.. Following ART roll-out, the incidence of BSI has fallen and clinical outcomes have improved markedly. Nonetheless, BSI incidence remains high in the first 3 months of ART despite CPT. Further interventions to reduce BSI-associated mortality in the first 3 months of ART require urgent evaluation.

Topics: Adult; Anti-HIV Agents; Bacteremia; Coinfection; Female; HIV Infections; Hospitals, Municipal; Humans; Incidence; Malawi; Male; Middle Aged; Prospective Studies; Risk Factors; Salmonella Infections; Sex Distribution; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

A 62-year-old patient with peritoneal dialysis (PD)-associated peritonitis is described. Identical strains of Pasteurella multocida and Streptococcus minor were cultured from the dialysate, and from the saliva of her recently adopted stray cat. Pasteurella is not often encountered as pathogen in PD-associated peritonitis, Streptococcus minor has never been cultured in human infection before. We emphasise the importance of hygiene in peritoneal dialysis and the need for testing pets when zoonotic pathogens are cultured.

Topics: Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Female; Humans; Middle Aged; Pasteurella Infections; Pasteurella multocida; Peritoneal Dialysis; Peritonitis; Saliva; Streptococcal Infections; Streptococcus; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

Pharyngotonsillitis by β-hemolytic Streptococcus mostly affects children and immunocompromised, being Streptococcus pyogenes (Group A) the most common agent in bacterial pharyngotonsillitis.. This work targeted the research of β-hemolytic Streptococcus Group-A (SBHGA) and No-A (SBHGNA) in the oropharynx of individuals with special health needs from the APAE (Maceió-AL).. A prospective study with oropharynx samples from patients with Down syndrome and other mental disorders (test) and students from a private school (control) aged 5-15 years. Cultures in blood agar (5%) were identified through Gram/catalase tests and bacitracin/trimethoprim-sulfamethoxazole disk diffusion method, applying the chi-squared statistical analysis.. A total of 222 bacterial colonies were isolated in 74 individuals from APAE and 65 in the control group. In the test group, previous episodes of pharyngotonsillitis were reported by 36.49% (27/74) and 9.46% (7/74) were diagnosed with symptoms and/or signs suggestive of oropharynx infection. No positive sample of S. pyogenes was confirmed at APAE, being all samples classified as SBHGNA, with 5 SBHGA in the control group.. The early identification of β-hemolytic Streptococcus is important for the fast treatment of pharyngotonsillitis and the absence of S. pyogenes avoid future suppurative or not-suppurative sequels in the group from APAE.

Topics: Anti-Bacterial Agents; Case-Control Studies; Child; Disk Diffusion Antimicrobial Tests; Female; Humans; Intellectual Disability; Male; Pharyngitis; Prevalence; Prospective Studies; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis; Trimethoprim, Sulfamethoxazole Drug Combination

It is aimed to detect the sensitivity and specificity of rapid antigen detection of group A beta hemolytic streptococci from throat specimen compared with throat culture. The other goal of the study is to help in giving clinical decisions in upper respiratory tract infections according to the age group, by detection of sensitivity and positive predictive values of the rapid tests and throat cultures.. Rapid antigen detection and throat culture results for group A beta hemolytic streptococci from outpatients attending to our university hospital between the first of November 2005 and 31st of December 2008 were evaluated retrospectively. Throat samples were obtained by swabs from the throat and transported in the Stuart medium and Quickvue Strep A [Quidel, San Diego, USA] cassette test was applied and for culture, specimen was inoculated on 5% blood sheep agar and identified according to bacitracin and trimethoprim-sulphametaxazole susceptibility from beta hemolytic colonies.. During the dates between the first of November 2005 and 31st of December 2008, from 453 patients both rapid antigen detection and throat culture were evaluated. Rapid antigen detection sensitivity and specificity were found to be 64.6% and 96.79%, respectively. The positive predictive value was 80.95% whereas negative predictive value was 92.82%. Kappa index was 0.91. When the results were evaluated according to the age groups, the sensitivity and the positive predictive value of rapid antigen detection in children were 70%, 90.3% and in adults 59.4%, 70.4%.. When bacterial infection is concerned to prevent unnecessary antibiotic use, rapid streptococcal antigen test (RSAT) is a reliable method to begin immediate treatment. To get the maximum sensitivity of RSAT, the specimen collection technique used and education of the health care workers is important. While giving clinical decision, it must be taken into consideration that the sensitivity and the positive predictive value of the RSAT is quite lower in adult age group than in pediatric age group.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antigens, Bacterial; Bacitracin; Bacteriological Techniques; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Middle Aged; Pharyngitis; Respiratory Tract Infections; Retrospective Studies; Sensitivity and Specificity; Streptococcal Infections; Streptococcus pyogenes; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

The goal was to compare the clinical effectiveness of monotherapy with beta-lactams, clindamycin, or trimethoprim-sulfamethoxazole in the outpatient management of nondrained noncultured skin and soft-tissue infections (SSTIs), in a methicillin-resistant Staphylococcus aureus (MRSA)-endemic region.. A retrospective, nested, case-control trial was conducted with a cohort of patients from 5 urban pediatric practices in a community-acquired MRSA-endemic region. All subjects were treated as outpatients with oral monotherapy for nondrained noncultured SSTIs between January 2004 and March 2007. The primary outcome was treatment failure, defined as a drainage procedure, hospitalization, change in antibiotic, or second antibiotic prescription within 28 days.. Of 2096 children with nondrained noncultured SSTIs, 104 (5.0%) were identified as experiencing treatment failure and were matched to 480 control subjects. Compared with beta-lactam therapy, clindamycin was equally effective but trimethoprim-sulfamethoxazole was associated with an increased risk of failure. Other factors independently associated with failure included initial treatment in the emergency department, presence or history of fever, and presence of either induration or a small abscess.. Compared with beta-lactams, clindamycin monotherapy conferred no benefit, whereas trimethoprim-sulfamethoxazole was associated with an increased risk of treatment failure in a cohort of children with nondrained noncultured SSTIs who were treated as outpatients. Even in regions with endemic community-acquired MRSA, beta-lactams may still be appropriate, first-line, empiric therapy for children presenting with these infections.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Bacterial Infections; beta-Lactams; Case-Control Studies; Child; Child, Preschool; Clindamycin; Cohort Studies; Drug Therapy, Combination; Emergency Service, Hospital; Empiricism; Female; Hospitalization; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Philadelphia; Retrospective Studies; Skin Diseases, Bacterial; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Streptococcal Infections; Streptococcus pyogenes; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

To determine the microbiology, particularly the prevalence of MRSA, in pediatric patients with community-acquired bacterial lymphadenitis. Long considered a nosocomial organism, methicillin-resistant Staphylococcus aureus (MRSA) has recently emerged as a cause of community-acquired infections. Resistance to other classes of antibiotics, including clindamycin, is prevalent amongst S. aureus, as well.. A retrospective review of the medical records and culture results of patients under the age of 18 who underwent trans-cervical surgical drainage of abscessed lymph nodes between the years 2000 and 2006.. Sixty-two patients were identified for whom microbiology data were available. Six infections were classified as parapharyngeal on imaging; the remainder involved cervical chain lymph nodes. Forty-nine patients grew microorganisms on culture while 13 collections had no growth. The most common organism was S. aureus (63% of positive cultures); followed by beta-hemolytic group A Streptococcus (22%). Of S. aureus isolates, 27% were oxacillin-resistant (MRSA). All MRSA isolates were sensitive to clindamycin and trimethoprim/sulfamethoxazole; 63% were sensitive to ciprofloxacin, and 25% sensitive to erythromycin. Of methicillin-sensitive S. aureus isolates, 100, 86, and 82% were sensitive to trimethoprim/sulfamethoxazole, clindamycin, and ciprofloxacin, respectively. All MRSA isolates were identified during the latter half of the study period (2003-2006); none grew prior to 2003.. MRSA is a common pathogen in community-acquired lymphadenitis, and its incidence is rising. Resistance to clindamycin, a drug commonly used to treat MRSA, is prevalent amongst methicillin-sensitive S. aureus. This has important implications regarding the empiric treatment of lymphadenitis in children.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Ciprofloxacin; Clindamycin; Community-Acquired Infections; Erythromycin; Female; Humans; Infant; Lymphadenitis; Male; Methicillin Resistance; Neck; Oxacillin; Penicillin Resistance; Pharyngeal Diseases; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes; Trimethoprim, Sulfamethoxazole Drug Combination

Available data from the Southern Reunion Island Medical Group was processed to assess the evolution of Streptococcus pneumoniae resistance to antibiotics since 1994 when the first penicillin-non-susceptible S. pneumoniae (PNSSP) was identified. In addition, 249 strains, isolated between 1998 and 2004, were tested against telithromycin and moxifloxacin.. Between 1994 and 2004, the percentage of PNSSP increased from 0 to 59.2%. Among PNSSP, 13.9% were resistant strains in 2004 with MICs<4 microg/ml. Before 2001 the rate of resistance to penicillin was superior to 50%. In 2004, 15.8 and 8.7% of the isolated strains were of decreased susceptibility to amoxicillin and cefotaxime respectively while none were resistant to either treatment. Other antibiotics followed the pattern of resistance to penicillin. Between 1998 and 2004, resistance to erythromycin decreased from 42.5 to 35.1%, from 35.1 to 22.8% for cyclins, from 18.8 to 8.8 for chloramphenicol, and from 38.3 to 12.3% for cotrimoxazole. All tested strains were susceptible to both telithromycin and moxifloxacin.. Amoxicillin remains efficient for all strains isolated in the Reunion Island in 2004. The presence of strains with decreased susceptibility to third generation cephalosporins implies combination with vancomycin for empirical treatment of pneumococcal meningitis. Moxifloxacin can be used when using a fluoroquinolone is justified. Telithromycin is efficient even on strains resistant to erythromycin and consequently this molecule can be prescribed in the case of a required macrolide treatment.

Topics: Aza Compounds; beta-Lactams; Cephalosporin Resistance; Cephalosporins; Chloramphenicol; Drug Resistance, Multiple, Bacterial; Fluoroquinolones; Humans; Ketolides; Moxifloxacin; Penicillin Resistance; Quinolines; Retrospective Studies; Reunion; Rifampin; Streptococcal Infections; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

The objective of this study was to investigate the perceived increase in resistance of Streptococcus equi subsp. zooepidemicus (S. zooepidemicus) isolated from the lower respiratory tract of horses to trimethoprim-sulfamethoxazole (SXT). The recorded SXT-susceptibility results of 50 S. zooepidemicus isolates from the tracheal wash fluid of equine patients examined at Colorado State University Veterinary Teaching Hospital from each of 2 time periods (1987-1990 and 1997-2001) were compared and statistically analyzed using a cross-sectional study design. There was a statistically significant difference between the documented resistance of S. zooepidemicus isolated in the 1987-1990 time period (8%), using quantitative microbroth dilution, and the resistance reported for isolates from the 1997-2001 time period (42%), using Kirby-Bauer agar disk diffusion. Laboratory investigation revealed inadequate quality control of media and subsequent falsely reported resistance of S. zooepidemicus from 1997 to 2001 time period. This study demonstrates how minor deviations from prescribed laboratory-testing guidelines can have a major effect on antimicrobial susceptibility test results. The study also underscores the need for regular surveillance and monitoring of trends in antimicrobial susceptibility to detect and correct such problems. In addition, epidemiologists and others collecting data from laboratories should be cautioned to interact with the laboratory regarding interpretation of results of various testing methods to ensure accurate analysis and conclusions.

Topics: Animals; Anti-Infective Agents; Cross-Sectional Studies; Culture Media; Drug Resistance, Bacterial; Horse Diseases; Horses; Microbial Sensitivity Tests; Quality Control; Respiratory Tract Infections; Retrospective Studies; Streptococcal Infections; Streptococcus equi; Trimethoprim, Sulfamethoxazole Drug Combination

Not only is Group A beta-hemolytic Streptococcus (GAS) the most frequent cause of bacterial pharyngitis, it is also the culprit in various skin and systemic infections, acute rheumatic fever, post streptococcal glomerulonephritis, and other disorders and complications. A new, ready-to-use media, Dio-Bacit, in a two section plate containing 5% sheep blood agar on one side and sheep blood agar with bacitracin (2 microg/ml) on the other was compared for its efficiency in identifying GAS with bacitracin and bacitracin + sulphamethaxazole / trimethoprim disk tests applied after isolation of beta-hemolytic colonies. We also used the latex-agglutination test as the gold standard method for differentiating GAS from streptococci belonging to other groups. Compared with the latex-agglutination test, we found the sensitivity and specificity of the Dio-Bacit method to be 92.0% and 96.9%, respectively. Dio-Bacit plates provide an easy and very useful way to identify GAS within one day, saving time, labor, and money for routine diagnostic microbiology laboratories.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Bacitracin; Bacteriological Techniques; Child; Culture Media; Female; Humans; Latex Fixation Tests; Male; Microbial Sensitivity Tests; Pharyngitis; Sensitivity and Specificity; Streptococcal Infections; Streptococcus pyogenes; Trimethoprim, Sulfamethoxazole Drug Combination

The occurrence of oral penicillin-resistant viridans group streptococci (VGS) was studied in 50 patients with either newly diagnosed acute leukaemia or autologous peripheral stem cell transplants. One patient was excluded because of Staphylococcus aureus growth in the stem cell harvest. VGS were isolated from the oral cavity of 48 of the remaining 49 patients. Of these 48 patients, 12 (25%) yielded VGS resistant (MIC > 2 mg/L) to penicillin. These 12 patients had a higher frequency of septicaemia (p 0.04) and more days of treatment with trimethoprim-sulphamethoxazole (p 0.04) than patients who harboured susceptible or intermediately resistant VGS (MIC 2 mg/L). There were no other statistically significant differences between the two groups. It is important to be aware of the high level of penicillin resistance in oral VGS in patients with haematological disease, and this parameter should be considered when selecting antibiotic therapy for cases of septicaemia caused by VGS in immunocompromised patients.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Female; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Microbial Sensitivity Tests; Middle Aged; Mouth Mucosa; Penicillin Resistance; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prospective Studies; Stem Cell Transplantation; Streptococcal Infections; Sweden; Trimethoprim, Sulfamethoxazole Drug Combination; Viridans Streptococci

The nasopharyngeal colonization rate of Streptococcus pneumoniae and its antibiotic susceptibility was determined in a given population of 317 young children (ages 1-7 years) in the area of Bari, Italy. 18.29% of the cultures were positive for S. pneumoniae. 8.62% of the strains were intermediately resistant to penicillin. Erythromycin-(65.51%) and cotrimoxazole-(17.24%) resistance was also observed whereas all the strains resulted uniformely susceptible to cefotaxime and ceftriaxone. The high rate of nasopharyngeal carriage of Streptococcus pneumoniae along with the resistance to antibiotics widely used in the community suggests the importance of epidemiological surveillance as well as the application of new vaccine strategies.

Topics: Carrier State; Child; Child, Preschool; Cohort Studies; Drug Resistance, Bacterial; Erythromycin; Female; Humans; Infant; Macrolides; Male; Microbial Sensitivity Tests; Nasopharynx; Serotyping; Streptococcal Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

The frequency of isolation of viridans streptococci from the blood of neutropenic patients with cancer has significantly increased over the course of the last 10-15 years. Risk factors in this patient population include severe neutropenia, oral mucositis, administration of high-dose cytosine arabinoside, and antimicrobial prophylaxis with either trimethoprim-sulfamethoxazole or a fluoroquinolone. In some patients with cancer and neutropenia who develop viridans streptococcal bacteremia, a toxic shock-like syndrome has been described; Streptococcus mitis has been the causative species in most cases. Because resistance of viridans streptococci to a variety of antimicrobial agents is increasingly recognized, penicillin susceptibility cannot be assumed, and empirical vancomycin therapy should be used to treat neutropenic patients with cancer who have shock or are developing acute respiratory distress syndrome. Given the seriousness of septicemia caused by viridans streptococci and the potential for selection of other resistant microorganisms, the routine practice of antimicrobial prophylaxis for neutropenic patients with cancer should be reconsidered.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Fluoroquinolones; Humans; Neutropenia; Risk Factors; Streptococcal Infections; Streptococcus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To determine whether treatment with an antibiotic (trimethoprim-sulfamethoxazole) reduced the inflammatory response in a murine form of Streptococcus pneumoniae-induced rhinosinusitis.. We randomized 18 C57BL/6 mice to either treatment with intraperitoneal trimethoprim-sulfamethoxazole (Bactrim, 30 mg/kg) or no treatment (control). After 2 days, we inoculated all C57BL/6 mice intranasally with a Bactrim-susceptible strain of Streptococcus pneumoniae, ATCC 49619, suspended in Trypticase soy broth. At day 5 after bacterial inoculation, we sacrificed the mice and prepared histopathologic sections of their sinuses after culturing their nasal cavities by lavage.. Animal care facility at a tertiary, academic institution.. The histopathologic sections of the sinuses were examined in a blind manner for the percent of sinus cavity area occupied by neutrophil clusters, and for the number of neutrophils per square millimeter of sinus mucosa.. The Bactrim group had a significantly smaller sinus area occupied by neutrophil clusters (1.58% +/- 1.13 vs 4.38% +/- 3.41; P < 0.05), significantly fewer neutrophils infiltrating the mucosa (58.81 +/- 29.63/mm2 vs 105.85 +/- 48.49/mm2; P < 0.05), and significantly less growth of Streptococcus pneumoniae colonies in the intranasal cultures (8 few and 1 moderate vs 3 few, 3 moderate, and 1 many; P = 0.05) compared to the control group.. In our murine model of acute rhinosinusitis, Bactrim decreased the number of neutrophil clusters in the sinus cavities, the number of neutrophils infiltrating the sinus mucosa, and the growth of Streptococcus pneumoniae. We propose that our murine model can be used for the study of the pathophysiology and treatment of acute rhinosinusitis.

Topics: Animals; Disease Models, Animal; Inflammation; Leukocyte Count; Mice; Neutrophils; Rhinitis; Sinusitis; Streptococcal Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

A 19-year-old Quarter Horse mare was evaluated because of bloody vaginal discharge that was apparent immediately following breeding. On transrectal ultrasonography, it was evident that the uterus was filled with fluid containing echogenic particles; linear hyperechoic structures were also visible. Endoscopy was performed, which revealed a number of bones adhered to the cranial wall and floor of the right uterine horn as well as purulent fluid in both uterine horns. Bacterial endometritis and fetal maceration were diagnosed. The mare was treated with antibiotics, and the fetal bones were manually removed from the uterus. Fetal maceration with intrauterine retention of bones is rare in mares. Use of hysteroscopy supplements ultrasonography in the diagnosis of uncommon conditions of the uterus. Macerated bones may be adhered to the endometrium, thereby requiring manual removal.

Topics: Abortion, Veterinary; Animals; Bone and Bones; Cattle; Dinoprost; Endometritis; Female; Fetus; Horse Diseases; Horses; Hysteroscopy; Oxytocics; Pregnancy; Progesterone; Streptococcal Infections; Streptococcus equi; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Uterus; Vaginal Discharge

A number of 689 Streptococcus suis isolates collected nationwide from diseased and healthy pigs from 1987 to 1996 were surveyed for antibiotic susceptibilities to 11 drugs. No isolates resistant to amoxicillin, chloramphenicol, and sulfamethoxazole/trimethoprim were found. Isolates were highly susceptible to penicillins (penicillin G, ampicillin, and amoxicillin) except cloxacillin. They were not susceptible to tetracycline, streptomycin, and kanamaycin (MIC90 50 microg/ml, > or = 100 microg/ml, and > or = 100 microg/ml, respectively). Multiple-resistant isolates (> or = 3 antimicrobial agents) were found in 20.3% of all isolates tested.

Topics: Animals; Anti-Bacterial Agents; Chi-Square Distribution; Chloramphenicol; Drug Resistance, Microbial; Drug Resistance, Multiple; Health Surveys; In Vitro Techniques; Japan; Microbial Sensitivity Tests; Penicillins; Streptococcal Infections; Streptococcus suis; Swine; Swine Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

The aetiology, clinical characteristics and outcome of bacteraemia in patients with acute myeloid leukaemia were studied. All positive blood cultures collected at a haematological ward during 2 7-y periods were evaluated. Altogether, 274 episodes of bacteraemia in 152 patients were recorded, 80 episodes during 1980-86 and 194 during 1990-96. During the 2 periods, trimethoprim-sulfamethoxazol in combination with amikacin was the first-line empirical therapy in patients with neutropaenia and fever. In 1990, antimicrobial prophylaxis with ciprofloxacin and fluconazole was introduced. The incidence of bacteraemia due to viridans streptococci or coagulase-negative staphylococci increased from the first period to the second, whereas the incidence of Enterobacteriaceae decreased. In granulocytopaenic patients during 1990-96, viridans streptococci accounted for 21% of the isolates and in patients treated prophylactically with fluoroquinolone, viridans streptococci accounted for 31%. All viridans streptococci were sensitive to penicillin. At the time of the positive blood cultures, the patients of the second period were granulocytopaenic in 83% of the episodes. The mortality related to septicaemia during the later period was 13% and only 1 of 33 (3%) of the patients with viridans streptococci died. Eight patients (9%) died in relation to septicaemia following curative antileukaemic therapy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amikacin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteremia; Ciprofloxacin; Drug Resistance, Microbial; Female; Fluconazole; Humans; Incidence; Leukemia, Myeloid, Acute; Male; Middle Aged; Neutropenia; Penicillins; Streptococcal Infections; Streptococcus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Bacteremia may occur after disruption of the oral mucous membrane, particularly after dental treatment. 18 mentally handicapped patients who underwent dental treatment with general anesthesia were included in our study. None of the patients had general illnesses or received antibiotic protection. From each patient several blood samples were drawn aseptically during dental treatment and cultured. The majority of aerobic bacteria recovered belonged to Streptococcus sp and Gemella sp., anaerobic bacteria mainly belonged to Porphyromonas gingivalis and Peptostreptococcus sp. Resistance of the isolated bacteria to penicillin as well as to oxacillin, erythromycin and Co-trimoxazole was substantial. The highest resistance rate could be shown against fucidic acid.

Topics: Adolescent; Adult; Anesthesia, Dental; Anesthesia, General; Anti-Bacterial Agents; Bacteremia; Bacteroidaceae Infections; Dental Care; Drug Resistance, Microbial; Erythromycin; Fusidic Acid; Gram-Positive Bacterial Infections; Humans; Intellectual Disability; Oxacillin; Penicillin Resistance; Penicillins; Peptostreptococcus; Porphyromonas gingivalis; Streptococcal Infections; Streptococcus; Trimethoprim, Sulfamethoxazole Drug Combination

With use of standardized techniques, a study of nasopharyngeal pneumococcal carriage in children in six Central and Eastern European cities was undertaken during the winter of 1993-1994. Nasopharyngeal swab specimens were collected from 954 children (predominantly under the age of 5 years) who were hospitalized or attending outpatient clinics or day-care centers. Susceptibility of isolates was determined by disk diffusion (on Mueller-Hinton agar with 5% sheep blood). Disks containing 1 micrograms of oxacillin were used to screen for susceptibility to penicillin G. Pneumococci were recovered from 258 (27.0%) of the 954 children. A variety of strains were recovered, and most penicillin-resistant strains were ŕesistant to multiple agents. Minimum inhibitory concentrations of penicillin for selected resistant strains were 0.125-8 micrograms/mL. Resistance to penicillin was common in strains from Bulgaria, Romania, and Slovakia. Resistance to erythromycin and chloramphenicol occurred in Bulgarian and Romanian strains. Strains from Poland were all susceptible to penicillin, but many were resistant to tetracycline. Resistance to trimethoprim-sulfamethoxazole was common in Bulgarian, Romanian, and Slovak strains. Czech and Russian strains were predominantly susceptible to antibiotics. Most resistant strains were of serotypes 6, 14, 19, and 23.

Topics: Carrier State; Child; Child, Preschool; Chloramphenicol Resistance; Drug Resistance, Microbial; Erythromycin; Europe; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Nasopharynx; Penicillin Resistance; Serotyping; Streptococcal Infections; Streptococcus pneumoniae; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Nasopharyngeal carriage of Streptococcus pneumoniae was studied in 162 healthy infants at ages 2, 4, 6, 7, 12, and 13 months and in an additional 352 healthy children at ages 12, 15, 18, 21, and 24 months. Carriage was 26%, 39%, and 62% at 2, 12, and 24 months, respectively, and the respective resistance to > or = 1 antibiotic was 11%, 19%, and 27%. The presence of an older sibling or antibiotic treatment during the month preceding the culture was associated with carriage of resistant pneumococci in infants, whereas attendance at large day care centers was associated with carriage during the second year of life. Antibiotic resistance was detected in all 7 serotypes included in the candidate pediatric conjugate vaccines and was significantly more prevalent among vaccine-type pneumococci than among non-vaccine-type pneumococci. The use of conjugate vaccines may reduce the spread of resistant pneumococci.

Topics: Anti-Bacterial Agents; Bacterial Vaccines; Bacteriological Techniques; Carrier State; Child Day Care Centers; Child, Preschool; Clindamycin; Drug Resistance, Microbial; Erythromycin; Humans; Infant; Israel; Nasopharynx; Penicillins; Streptococcal Infections; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccination

The antibiotic susceptibility of pneumococci isolated from clinical specimens from 1991 through 1994 was investigated. Of 305 strains tested by the agar dilution method, 16 (5.2%) were resistant to penicillin (MICs > or = 0.12 mg/l). Of the resistant strains, 0.3% showed high-level resistance (MIC > or = 2 mg/l). The rate of resistance to erythromycin (MIC > or = 4 mg/l) was 2.3%, to tetracycline (MIC > or = 8 mg/l) 8.5%, to chloramphenicol (MIC > or = 8 mg/l) 1.0%, and to trimethoprim sulfamethoxazole (MIC > or = 3.2/64 mg/l) 3.3%. Penicillin-resistant strains showed significantly higher resistance to the other antibiotics tested. Resistance to penicillin was higher in isolates from the respiratory tract than in those from blood and cerebrospinal fluid (6.2% vs. 2.4%, respectively). There was no increase in penicillin resistance from 1991 through 1994 (5.3% vs. 4.9%, respectively).

Topics: Anti-Bacterial Agents; Austria; Bronchitis; Chloramphenicol Resistance; Erythromycin; Humans; Microbial Sensitivity Tests; Nasopharynx; Penicillin Resistance; Sinusitis; Sputum; Streptococcal Infections; Streptococcus pneumoniae; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Resistance patterns of S. pneumoniae and H. influenzae to standard antibiotics in Thailand is not on the rise when compared to previous reports. There is no need at present to change standard antibiotic therapy recommendations for pneumonia by the National ARI. The use of antibiotics for the treatment or prophylactic purposes should be judicious to limit the spread of antimicrobial resistance. This study is the main part of a National surveillance for antimicrobial resistance of S. pneumoniae and H. influenzae. The surveillance programme should be continued to evaluate trends in order to up-date guidelines for the selection of antibiotics of the ARI programme in the future.

Topics: Ampicillin; Anti-Bacterial Agents; Child, Preschool; Chloramphenicol; Drug Resistance, Microbial; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Penicillins; Respiratory Tract Infections; Streptococcal Infections; Streptococcus pneumoniae; Thailand; Trimethoprim, Sulfamethoxazole Drug Combination

A total of 952 consecutive vaginal swabs were obtained from patients who attended obstetric or gynecologic clinics affiliated with the Children's Hospital of Buffalo, New York. Swabs were cultured comparatively on 5% sheep blood agar (BA), selective sheep blood agar containing 1.25 micrograms/ml trimethoprim-23.75 micrograms/ml sulfamethoxazole (SXT), and Lim broth (Todd-Hewitt broth containing 1% yeast extract, 10 micrograms/ml colistin, and 15 micrograms/ml nalidixic acid). A total of 168 swabs (18%) were positive (by at least one method) for group B Streptococcus (GBS). The overall agreement among the three techniques was 90% (858 of 952); 94 specimens (10%, 94 of 952) had discrepant results, and 74 of these (44%, 74 of 168) were positive, only by Lim as opposed to two (1%) and 0 by BA and SXT, respectively. There were only two (2%, 2 of 168) false negative for Lim as compared with 82 (49%) for BA and 86 (51%) for SXT. Thus, the sensitivity of GBS detection by BA, SXT, and Lim is 51%, 49%, and 99%, respectively. These data suggest that the use of Lim broth increases the recovery rate of GBS by 48% after 48 h while the use of the SXT plate reduced the recovery rate by 2% as compared with the conventional BA plate.

Topics: Anti-Bacterial Agents; Colistin; Culture Media; Female; Humans; Nalidixic Acid; Pregnancy; Pregnancy Complications, Infectious; Risk Factors; Sensitivity and Specificity; Streptococcal Infections; Streptococcus agalactiae; Trimethoprim, Sulfamethoxazole Drug Combination; Vagina

Pneumocystis carinii pneumonia has been the most common life-threatening opportunistic infection in patients with acquired immunodeficiency syndrome. With a better understanding of the natural history of HIV infection, however, we have come to realize that prophylaxis against P carinii can prevent the majority of such pneumonias. In this article, I focus on the rationale behind such prophylaxis, as well as the choices and dilemmas the clinician faces in deciding on the most appropriate therapy and when it should be instituted.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Clindamycin; Dapsone; Drug Therapy, Combination; Humans; Pneumonia, Pneumocystis; Primaquine; Pyrimethamine; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

This prospective study shows that acute peritonsillar abscess can be successfully treated by three-point puncture and aspiration. The results (recurrence in 19%) are comparable with published data on drainage of the peritonsillar space through the incision procedure. By proper selection of patients, the rate of recurrences can be further reduced. Because the occurrence of Streptococcus pyogenes in the aspirate seems to be associated with a favorable prognosis of therapy with puncture and antibiotics only, testing for the presence of this bacterial species might give a useful clue to the type of treatment needed. If the bacterial culture shows mixed aerobic and anaerobic flora, but not S pyogenes, and if the patient has a history of recurrent tonsillitis, incision or proceeding directly to tonsillectomy may be the best therapeutical choice.

Topics: Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; Bacteria; Biopsy, Needle; Erythromycin; Follow-Up Studies; Gram-Negative Anaerobic Bacteria; Gram-Negative Bacterial Infections; Humans; Middle Aged; Penicillin V; Peritonsillar Abscess; Prospective Studies; Punctures; Recurrence; Streptococcal Infections; Streptococcus pyogenes; Tonsillectomy; Tonsillitis; Trimethoprim, Sulfamethoxazole Drug Combination

The computerized outpatient records of the Harvard Community Health Plan, a 230,000-member health maintenance organization, were used to determine the frequency with which serum sickness is recognized in the practice setting after exposure to antibiotics. The medical records of 3,487 children who had been prescribed cefaclor or amoxicillin were searched in December 1986 for coded diagnoses of serum sickness and related conditions. Diagnoses were validated by blinded review of dictated and written office notes. There were 12 cases of serum sickness in 11,523 child-years. During this time, these children were prescribed 13,487 courses of amoxicillin, 5,597 courses of trimethoprim-sulfamethoxazole (TMP-SMZ), 3,553 courses of cefaclor, and 2,325 courses of penicillin V. Serum sickness was considered to be antibiotic-related if it occurred within 20 days of initiation of antibiotic therapy. Five cases were temporally associated with cefaclor, one with both amoxicillin and TMP-SMZ, four with TMP-SMZ alone, and one with penicillin V alone. One case was not associated with any antibiotic exposure. All antibiotic-related cases occurred in children under age 6 years who were treated for otitis media or streptococcal pharyngitis, and most cases began 7-11 days after initiation of antibiotic. All but one of the antibiotic-related cases occurred in children who had relatively heavy lifetime antibiotic exposure. The risk of serum sickness was significantly elevated after cefaclor compared with amoxicillin, even among the most heavily exposed children (relative risk = 14.8, p = 0.01, 95% confidence interval 2.0-352.0). Most cases prompted several physician visits, but none required hospitalization.

Topics: Adolescent; Amoxicillin; Cefaclor; Cephalexin; Child; Child, Preschool; Female; Health Maintenance Organizations; Humans; Incidence; Infant; Infant, Newborn; Information Systems; Male; Massachusetts; Otitis Media; Penicillin V; Pharyngitis; Seasons; Serum Sickness; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

To assess the potential efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) against serious enterococcal infections, we used a rat enterococcal endocarditis model comparing TMP-SMX therapy (500 mg of TMP plus 2,500 mg of SMX per kg of body weight per day given every 8 h by intragastric gavage) with intravenous ampicillin therapy (1,000 mg/kg per day). Despite concentrations of active drug in serum well in excess of the MIC and MBC, the mean residual vegetation bacterial titer in TMP-SMX-treated rats was similar to that in untreated controls (8.4 +/- 1.1 versus 8.6 +/- 1.3 log10 CFU/g) and significantly higher than that in the ampicillin-treated group (3.6 +/- 1.5 log10 CFU/g; P less than or equal to 0.001). This demonstrates discordance between in vitro activity and in vivo efficacy of TMP-SMX in serious enterococcal infection.

Topics: Ampicillin; Animals; Dose-Response Relationship, Drug; Endocarditis, Bacterial; Enterococcus faecalis; Humans; Infusions, Intravenous; Male; Random Allocation; Rats; Rats, Inbred Strains; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Lethal enterococcal peritonitis in mice was used to compare trimethoprim-sulfamethoxazole (TMP-SMX) therapy with ampicillin therapy. Peritoneal fluid showed a 10(3)-CFU decrease in enterococci with ampicillin compared with TMP-SMX. Mortality of the untreated mice was 100%, compared with 40% for ampicillin and 95% for TMP-SMX, despite adequately measured levels in serum and peritoneal fluid.

Topics: Ampicillin; Animals; Disease Models, Animal; Enterococcus faecalis; Female; Injections, Intramuscular; Mice; Mice, Inbred Strains; Peritonitis; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Erythromycin; Humans; Streptococcal Infections; Streptococcus pyogenes; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Humans; Streptococcal Infections; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Humans; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

In January, February and March 1987, the frequency of Group A beta hemolytic streptococcus among 468 patients with acute tonsillopharyngitis who admitted to Dr. Sami Ulus Children's Hospital was % 41. Ten day procaine penicillin therapy was not successful in the % 29.5 patients. Cefadroxil (Duricef), clavulanic acid-amoxicillin combination (Augmentin) and erythromycin were tried in these patients. While the success rate of Duricef therapy was % 55, the results of other drug therapies were not been successful.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Cefadroxil; Child; Child, Preschool; Drug Combinations; Erythromycin; Female; Humans; Male; Penicillin G Procaine; Penicillin Resistance; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes; Sulfamethoxazole; Tonsillitis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A 12 year old boy was admitted to hospital with fever, general malaise, cough and peripheral edema. The patient who have had rheumatic heart diseases-mitral insufficiency was found to be in congestive cardiac failure. In blood cultures Staphylococcus aureus and Alpha-hemolytic streptococcus grew. The regimens of Cephalothin-Gentamicin, Methicillin-Tobramicin, to which the organism were sensitive were given intravenously. On these therapy the patient continued to have fever. He was put on Trimethoprim-Sulfomethoxazole intramuscularly. He became afebril for the first time. After two weeks fever recurred. In spite of medical treatment, the infection persisted and the indication for surgery was considered. Mitral valve replacement with a Starr-Edwards prosthesis was carried out. Postoperatively, the patient was treated with TMP-SMZ. For the past 10 months the patient has remained afebril and without evidence of congestive heart failure.

Topics: Child; Combined Modality Therapy; Drug Combinations; Endocarditis, Bacterial; Humans; Male; Mitral Valve; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

In Alice Springs and its vicinity, a single nasal swab was collected from 282 Australian aborigines in May 1981 to determine nasal carriage rates of pneumococci. Each swab was inoculated on blood agar and on gentamicin blood agar. The carriage rates were 89% in children, 39% in adolescents and 34% in adults. In all, 27 serotypes of pneumococci were met with and 15 (4%) of subjects yielded two or more serotypes. In children, types 23, 19, 6, 22 and 6 were predominant (in that order), whereas type 3 was commonest in older subjects. Approximately 25% children and 5% adults yielded drug-insensitive pneumococci. Resistance to benzylpenicillin, tetracycline and co-trimoxazole was met with, resistant pneumococci showed five resistance patterns and belonged to nine serotypes, predominantly types 19 and 23. All isolates were sensitive to chloramphenicol, erythromycin, lincomycin and rifampicin. The carriage rate of drug-insensitive pneumococci was 100-fold higher amongst children sampled than in non-aboriginal children in Australia.

Topics: Adolescent; Adult; Age Factors; Aged; Anti-Bacterial Agents; Australia; Bacterial Vaccines; Carrier State; Drug Combinations; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Middle Aged; Nasal Mucosa; Native Hawaiian or Other Pacific Islander; Pneumococcal Vaccines; Serotyping; Streptococcal Infections; Streptococcus pneumoniae; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The bacterial flora in the urine samples of 15 nursing home patients with long-term, indwelling catheters were examined monthly for one year. There was a rapidly changing polymicrobial flora averaging 2.0 changes per month in species with colony counts greater than 100,000/mL, and 3.2 changes per month when changes in species, biogram, and quantity of bacteria were considered. The flora changed significantly more frequently, and cultures of Pseudomonas aeruginosa, Providencia stuartii, and Citrobacter diversus were significantly more frequent in those receiving sulfamethoxazole and trimethoprim prophylaxis than in those who did not. There was no difference in incidence of urinary tract infection (UTI) between those patients who received sulfamethoxazole and trimethoprim prophylaxis and those who did not. Ampicillin or gentamicin was effective against 99% of species cultured that are of established UTI pathogenicity. Owing to the rapidity of bacterial flora changes, routine monthly cultures are of little predictive value in patients with indwelling catheters. This study does not support the efficacy of sulfamethoxazole and trimethoprim prophylaxis in such patients.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Bacteriuria; Catheters, Indwelling; Citrobacter; Drug Combinations; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Nursing Homes; Prospective Studies; Providencia; Streptococcal Infections; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization

Two patients with uncomplicated enterococcal urinary tract infections were treated with trimethoprim-sulfamethoxazole based on in vitro susceptibilities. Bacteremia developed in both patients and they recovered only after the cessation of trimethoprim-sulfamethoxazole administration and institution of therapy with penicillin G potassium or vancomycin hydrochloride plus streptomycin sulfate. Although the enterococcus may appear susceptible to trimethoprim-sulfamethoxazole in vitro, it escapes the antifolate activity of the drug in vivo by its unique ability to incorporate preformed exogenous folates. The practice by clinical microbiology laboratories of reporting the susceptibilities of the enterococcus to drugs other than the penicillins or vancomycin is misleading and potentially dangerous.

Topics: Drug Combinations; Drug Therapy, Combination; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Penicillins; Sepsis; Streptococcal Infections; Streptococcus; Streptomycin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vancomycin

The bacteriologic detection of group A Streptococcus in pharyngitis is vital in everyday practice to prevent serious potential sequelae. The purposes of this study were to determine whether throat cultures should be incubated in anaerobic atmosphere and whether an increased recovery rate could be obtained by stabbing of the plates (partial anaerobiosis) and by using a sulfamethoxazole-trimethoprim disk to enhance growth and identification. We examined 243 throat cultures, in duplicate, which were incubated in room air and in anaerobiosis (carbon dioxide, 10%). We found that, in aerobic incubation, the recovery rate of group A streptococci was 5.7%; in anaerobic incubation it was 19.8%. Stabbing of the agar to create a partial anaerobiosis was useless. When directly placed on the plate, the sulfamethoxazole-trimethoprim disk facilitated the identification of beta-hemolysis areas. To achieve maximum detection of group A streptococci in specimens obtained from the throats of infected children, we found that anaerobic incubation should be used.

Topics: Anaerobiosis; Bacteriological Techniques; Child; Child, Preschool; Culture Media; Drug Combinations; Humans; Pharyngitis; Pharynx; Streptococcal Infections; Streptococcus pyogenes; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Infections of 12 cerebrospinal fluid (CSF) shunts in 11 children were treated with oral systemic antibiotic therapy plus daily intrashunt injections of antibiotics. Eight patients were infected with Staphylococcus epidermidis (four patients) or Staphylococcus aureus (four patients), and were treated with intrashunt vancomycin, plus oral trimethoprim/sulfamethoxazole (T/S), plus oral rifampin. One of these eight patients was later changed to a course of intrashunt cephapirin and oral cephalexin plus oral rifampin. One patient with Micrococcus varians infection was treated with oral T/S and rifampin, without intrashunt therapy, another patient with Pseudomonas cepacia infection was treated with intrashunt kanamycin plus oral T/S, and a third with Corynebacterium sp. infection was treated with intrashunt vancomycin plus oral T/S. Eight of the 11 patients required some form of shunt surgery, the most common being temporary externalization of the peritoneal end of the catheter. Only two shunts were completely replaced (both were ventriculojugular shunts which were changed to ventriculoperitoneal shunts). Nine of 10 evaluable cases were considered cured of their infections. The patient treated with cephalosporins had an uncorrected shunt malfunction and relapsed 1 month after completing therapy. The authors have shown that CSF shunts infected with Staphylococci can be effectively cleared with daily intrashunt vancomycin plus systemic therapy with oral T/S and rifampin. Less common infections may also be amenable to this form of therapy. Revision surgery, if necessary, should be carried out during the antibiotic therapy.

Topics: Administration, Oral; Cerebrospinal Fluid Shunts; Child; Child, Preschool; Corynebacterium Infections; Drug Combinations; Female; Humans; Infant; Kanamycin; Male; Micrococcus; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin